The term “epilepsy” derives from a Greek word which literally means: “to be caught by surprise”. From the medical point of view, this general term actually specifies several and distinct clinical conditions; to date, over 40 different types of epilepsy are classified. In ancient times it was thought that epilepsy could be linked to adverse deities or even to witchcraft: for this reason, this disease has unfortunately been accompanied for centuries by fear and prejudices, particularly related to ignorance. Throughout history numerous people affected by epilepsy excelled as leaders, artists, writers, sportsmen, etc.
Epileptic seizures are manifestations due to a sudden, excessive and rapid discharge of a more or less large population of neurons in a specific area of the brain. Neurons communicate with each other through electrical impulses that switch on and off with a regular rhythm. These abnormal discharges (caused by epilepsy) between the brain cells can determine sensations or prompt actions beyond the control of the patient: it is possible to perceive tactile sensations, smells, sounds, tastes, images (often altered), or to experience either shaking or stiffening of a limb, as well as shaking of the whole body (convulsions). These events can lead to a total or partial loss of contact with the surrounding environment and with the people around us.
What are the symptoms of epilepsy?
In partial seizures, the symptoms depend on the area of the brain which is affected. Therefore, depending on the involvement of, e.g., the motor, or the sensitive, or the speech area, sudden or abnormal movements, tingling or sensory disturbances, or difficulty in speaking may arise. Visual and gustatory phenomena, and disorders that are more difficult to diagnose are also possible, such as behavioral alterations, feelings of estrangement or deja vus.
Among generalized seizures, the most common types are absences (petit mal) and tonic-clonic seizures (grand mal). In absences seizures, the individual suddenly becomes unconscious, often with open eyes, but usually without falling or showing motor disorders. In grand mal crises, the loss of consciousness is accompanied by the appearance of diffuse muscular contractions, which normally cause the patient to fall to the ground, sometimes with significant trauma; there is often mandibular contracture, temporary cyanosis of the face with respiratory obstruction, and subsequently a recovery period of very variable duration.
What to do during a seizure?
Normally the only measure to be taken in front of a person who is experiencing an epileptic seizure is to avoid, whenever possible, that movements and falls cause traumas. The best approach therefore consists in laying down the individual on the ground in a safe position or in placing a pillow under the head. Placing objects of any kind in the mouth can instead be dangerous, in addition to useless, since in the vast majority of cases the crises resolve themselves in a few minutes. On the other hand, the administration of medications during crises is reserved to healthcare personnel, and in some cases to caregivers, if properly trained to do so. It is very important not to panic and to carefully observe the individual, since a precise description of what happens to the patient during the seizure will subsequently be very useful for the doctor who will treat him/her.
Epilepsy: what are the causes?
The causes of epilepsy are several and depend on whether it is a partial or generalized form. In symptomatic focal epilepsy, the most common cause is the presence of structural lesions, such as ischemic or hemorrhagic areas, tumors, or even scars from previous trauma or surgery: in these cases we speak of secondary (or symptomatic) partial epilepsy. In other cases, even if there is clinical or instrumental evidence of the origin of the seizures from a specific brain area, radiological examinations such as computed axial tomography (CAT) or magnetic resonance imaging (MRI) may be unable to show any structural lesions: we therefore speak of cryptogenic focal epilepsy. In generalized epilepsy, there are idiopathic forms, in which it is believed that the patient, due to an individual or sometimes hereditary predisposition, has a reduced epileptogenic threshold for which the cerebral cortex can undergo an epileptic seizure even in the absence of causes or specific external stimuli. There are some predisposing conditions, such as abstinence or abuse of psychotropic drugs, acute or chronic alcoholism, metabolic or electrolyte disorders, which have the role of triggering factors in patients already suffering from epilepsy, but which in some cases may be the sole cause of the disease, and which must therefore be corrected. In the presence of these predisposing factors, or of a recent cerebral event, we speak of an acute, symptomatic crisis.
The tests for the diagnosis
The diagnosis of epilepsy is primarily clinical, i. e. based on an accurate description of the critical episodes reported by the patient, when possible, or by the people who observed the events when not. The most important diagnostic tests are the electroencephalogram (EEG) and the magnetic resonance (MRI) — or, if not possible, the CAT — of the brain. The EEG is a recording of the brain’s electrical activity that can draw attention to some anomalies called epileptiforms, which are possible signs, or sometimes pathognomonic symptoms, of an epileptic condition. The MRI of the brain, on the other hand, is essential to identify or to exclude a structural brain pathology, which must be considered in the decision to set up an antiepileptic treatment, and which must be treated from the etiological point of view, if possible. The EEG and the MRI of the brain can however be completely negative even in certain cases of epilepsy, so the first diagnostic step is always represented by an accurate anamnestic and neurological examination.
The treatment of epilepsy
While the single epileptic seizure does not require a pharmacological treatment, except that in particular cases, epilepsy as a disease – i.e., the trend of repeating epileptic seizures – always requires a treatment, which must be continued at least until the complete control of the crises. The first measure to be taken consists in removing the possible triggering factors, especially the abuse of psychopharmacological medications, alcohol and illicit drugs. This action can be sufficient in some cases, when these factors are the only root cause of the disease.
If, even after the removal of these triggers, the patient is still subject to seizures, then a pharmacological treatment must be carried out, with the purpose of eliminating, or at least controlling in the best possible way, the epileptic seizures.
In very specific cases, when there is a reduced response to the pharmacological treatment, a surgical treatment must be considered. This option requires a thorough selection of the patient and a multidisciplinary approach.